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1.  Transitions in Symptom Cluster Subgroups among Men Undergoing Prostate Cancer Radiation Therapy 
Cancer nursing  2016;39(1):3-11.
Prostate cancer is a common type of cancer worldwide and in the United States. However, little information has been reported on the symptoms of men overtime who receive radiation therapy.
Identify subgroups of men at pre-and post radiation therapy on general and treatment-related symptoms and to determine transitions in subgroup membership overtime.
Men (n=84) receiving completed questionnaires on fatigue, insomnia, pain, depression, anxiety, and sexual, urinary and bowel problems at pre-and posttreatment. Latent class analysis identified subgroups. One-way ANOVAs determined subgroups differed on symptoms, participant characteristics, and quality of life. Latent transition analysis examined subgroup transitions overtime.
At pretreatment four subgroups identified: Resilient group with little to no symptom reporting, Adjusted group with moderately high treatment-related symptoms, low insomnia, depression, and anxiety, Distressed group consistently high on most symptoms, and Emerging group with moderately high fatigue, depression, and anxiety with few treatment-related symptoms. At posttreatment similar results to groups at pretreatment: Resilient, Adjusted and Distressed groups with an Impacted group having high pain, insomnia, depression, urinary, and bowel symptoms. Quality of life and participant characteristics further distinguished groups at pre-and posttreatment. Income level predicted a transition in group membership.
Men can be classified into distinctly different subgroups overtime.
Implications for Practice
Assessment and intervention with men in subgroups such as Distressed and Emerging before and during treatment may lessen potential for remaining distressed, or moving into Impacted group where symptom severity is high at posttreatment. Interventions to reduce multiple symptoms are vitally needed.
PMCID: PMC4551659  PMID: 25730597
2.  Twelve-month effects of the COPE Healthy Lifestyles TEEN Program on Overweight and Depressive Symptoms in high school adolescents 
The Journal of school health  2015;85(12):861-870.
We evaluated the 12-month effects of the COPE (Creating Opportunities for Personal Empowerment) Healthy Lifestyles TEEN (Thinking, Emotions, Exercise, Nutrition) program versus an attention control program (Healthy Teens) on overweight/obesity and depressive symptoms in high school adolescents.
A cluster randomized controlled trial was conducted. Participants were 779 culturally diverse adolescents in the US Southwest. COPE is a cognitive-behavioral skills-building intervention with 20 minutes of physical activity integrated into a health course and taught by teachers once a week for 15 weeks. Outcome measures included body mass index (BMI) and depressive symptoms.
COPE teens had a significantly lower BMI at 12 months (F1, 698 = 11.22, p = .001) than Healthy Teens (24.95 versus 25.48). There was a significant decrease in the proportion of overweight and obese COPE teens from baseline to 12 months (χ2= 5.40, p = .02) as compared to Healthy Teens. For youth who began the study with extremely elevated depressive symptoms, COPE teens had significantly lower depression at 12 months compared to Healthy Teens (COPE M=42.39; Healthy Teens M=57.90); (F1, 12 = 5.78, p = .03).
COPE can improve long-term physical and mental health outcomes in teens.
PMCID: PMC5117907  PMID: 26522175
mental health outcomes; obesity; depression; health beliefs; health behavior
3.  Correlates of Depressive Symptoms After Birth for Latinas Who Are Overweight or Obese 
Depression symptoms and overweight/obesity are common concerns during childbearing. Both conditions are associated with poor outcomes at birth and can have long-lasting consequences. Predictors of depressive symptoms among overweight and obese low-income and ethnically diverse women are not known. Data are from the Madres para la Salud trial with 139 postpartum Latinas. Depressive symptoms during a prior pregnancy were positively related while social support and moderate intensity physical activity were negatively related to depressive symptoms after birth. Social support and physical activity may be effective interventions, particularly for women who have experienced depressive symptoms in a prior pregnancy.
PMCID: PMC4355166  PMID: 25383619
4.  Mujeres en Accion: Design and Baseline Data 
Journal of community health  2011;36(5):703-714.
The majority of programs designed to promote physical activity in older Hispanic women includes few innovative theory-based interventions that address cultural relevant strategies. The purpose of this report is to describe the design and baseline data for Mujeres en Accion, a physical activity intervention to increase regular physical activity, and cardiovascular health outcomes among older Hispanic women. Mujeres en Accion [Women in Action for Health], a 12 month randomized controlled trial to evaluate the effectiveness of a social support physical activity intervention in midlife and older Hispanic women. This study tests an innovative intervention, Mujeres en Accion, and includes the use of a theory-driven approach to intervention, explores social support as a theoretical mediating variable, use of a Promotora model and a Community Advisory group to incorporate cultural and social approaches and resources, and use of objective measures of physical activity in Hispanic women.
PMCID: PMC4620708  PMID: 21298400
Physical activity; Hispanic women; Health promotion; Older women
5.  Evaluating the Validity of an Automated Device for Asthma Monitoring for Adolescents: Correlational Design 
Symptom monitoring is a cornerstone of asthma self-management. Conventional methods of symptom monitoring have fallen short in producing objective data and eliciting patients’ consistent adherence, particularly in teen patients. We have recently developed an Automated Device for Asthma Monitoring (ADAM) using a consumer mobile device as a platform to facilitate continuous and objective symptom monitoring in adolescents in vivo.
The objectives of the study were to evaluate the validity of the device using spirometer data, fractional exhaled nitric oxide (FeNO), existing measures of asthma symptoms/control and health care utilization data, and to examine the sensitivity and specificity of the device in discriminating asthma cases from nonasthma cases.
A total of 84 teens (42 teens with a current asthma diagnosis; 42 without asthma) aged between 13 and 17 years participated in the study. All participants used ADAM for 7 consecutive days during which participants with asthma completed an asthma diary two times a day. ADAM recorded the frequency of coughing for 24 hours throughout the 7-day trial. Pearson correlation and multiple regression were used to examine the relationships between ADAM data and asthma control, quality of life, and health care utilization at the time of the 7-day trial and 3 months later. A receiver operating characteristic (ROC) curve analysis was conducted to examine sensitivity and specificity based on the area under the curve (AUC) as an indicator of the device’s capacity to discriminate between asthma versus nonasthma cases.
ADAM data (cough counts) were negatively associated with forced expiratory volume in first second of expiration (FEV1) (r=–.26, P=.05), forced vital capacity (FVC) (r=–.31, P=.02), and overall asthma control (r=–.41, P=.009) and positively associated with daily activity limitation (r=.46, P=.01), nighttime (r=.40, P=.02) and daytime symptoms (r=.38, P=.02), and health care utilization (r=.61, P<.001). Device data were also a significant predictor of asthma control (β=–.48, P=.003), quality of life (β=–.55, P=.001), and health care utilization (β=.74, P=.004) after 3 months. The ROC curve analysis for the presence of asthma diagnosis had an AUC of 0.71 (95% CI 0.58-0.84), which was significantly different from chance (χ2 1=9.7, P=.002), indicating the device’s discriminating capacity. The optimal cutoff value of the device was 0.56 with a sensitivity of 51.3% and a specificity of 72.7%.
This study demonstrates validity of ADAM as a symptom-monitoring device in teens with asthma. ADAM data reflect the current status of asthma control and predict asthma morbidity and quality of life for the near future. A monitoring device such as ADAM can increase patients’ awareness of the patterns of cough for early detection of worsening asthma and has the potential for preventing serious and costly future consequences of asthma.
PMCID: PMC4704980  PMID: 26475634
asthma; adolescent; ambulatory monitoring; device; cough; validity
6.  Worry Among Mexican American Caregivers of Community-Dwelling Elders 
This mixed methods, multi-site, National Institute of Nursing Research (NINR)-funded, interdisciplinary, descriptive study aimed to identify expressions of worry in qualitative data obtained from caregiving Mexican American (MA) families assisting older adults. The purpose of this portion of the inquiry was to determine how worry is expressed, what happens to caregivers when they worry, and what adaptive strategies they used. We examined semi-structured interviews completed during six in-home visits with 116 caregivers. We identified 366 worry quotations from 639 primary documents in ATLAS.ti, entered them into matrices, and organized findings under thematic statements. Caregivers expressed cultural and contextual worries, worried about transitions and turning points in care, and identified adaptive strategies. Despite these strategies, worry persisted. Constant worry may be an allied, important aspect of caregiver burden. We need additional longitudinal research to better understand the experience of MA caregivers for older adults and to provide empirically supported interventions, programs, and services that reduce worry.
PMCID: PMC4383164  PMID: 16684208
Mexican American; caregivers; worry; life course perspective
7.  Promoting Healthy Lifestyles in High School Adolescents 
Although obesity and mental health disorders are two major public health problems in adolescents that affect academic performance, few rigorously designed experimental studies have been conducted in high schools.
The goal of the study was to test the efficacy of the COPE (Creating Opportunities for Personal Empowerment) Healthy Lifestyles TEEN (Thinking, Emotions, Exercise, Nutrition) Program, versus an attention control program (Healthy Teens) on: healthy lifestyle behaviors, BMI, mental health, social skills, and academic performance of high school adolescents immediately after and at 6 months post-intervention.
A cluster RCT was conducted. Data were collected from January 2010 to May of 2012 and analyzed in 2012–2013.
A total of 779 culturally diverse adolescents in the U.S. Southwest participated in the trial.
COPE was a cognitive–behavioral skills-building intervention with 20 minutes of physical activity integrated into a health course, taught by teachers once a week for 15 weeks. The attention control program was a 15-session, 15-week program that covered common health topics.
Main outcome measures
Primary outcomes assessed immediately after and 6 months post-intervention were healthy lifestyle behaviors and BMI. Secondary outcomes included mental health, alcohol and drug use, social skills, and academic performance.
Post-intervention, COPE teens had a greater number of steps per day (p=0.03) and a lower BMI (p=0.01) than did those in Healthy Teens, and higher average scores on all Social Skills Rating System subscales (p-values <0.05). Alcohol use was 11.17% in the COPE group and 21.46% in the Healthy Teens group (p=0.04). COPE teens had higher health course grades than did control teens. At 6 months post-intervention, COPE teens had a lower mean BMI than teens in Healthy Teens (COPE=24.72, Healthy Teens=25.05, adjusted M= −0.34, 95% CI= −0.56, −0.11). The proportion of those overweight was significantly different from pre-intervention to 6-month follow-up (Chi square=4.69, p=0.03), with COPE decreasing the proportion of overweight teens, versus an increase in overweight in control adolescents. There were no differences in alcohol use at 6 months (p=0.06).
COPE can improve short- and more long-term outcomes in high school teens.
Trial registration
This study is registered at NCT01704768.
PMCID: PMC4285557  PMID: 24050416
8.  U.S. Cohort Differences in Body Composition Outcomes of a 6-Month Pedometer-Based Physical Activity Intervention: The ASUKI Step Study 
Regular physical activity (PA) enhances health and is an important factor in disease prevention and longevity. The 2008 U.S. Physical Activity Guidelines recommends that all healthy adults attain at least 150 minutes per week of moderate intensity aerobic PA (e.g., brisk walking) to maintain and promote PA.
This study determined the effects of a 6-month pedometer-based worksite walking intervention with participants focusing on a goal of achieving 10,000 steps per day, on body composition in adults with a wide range of body mass index (BMI) values and compares the changes with outcomes of similar studies.
Materials and Methods:
The design was a single group, quasi-experimental study. All participants received a pedometer and were asked to register the daily number of steps. Men and women (n = 142; age = 41 ± 11.5 years; BMI = 27.2 ± 7.25 kg.m-2) received body composition measures at 1, 3, and 6 months. A multilevel growth modeling approach was used to explore change over time and to predict change by steps, age, gender, and fat category categorized as normal and overweight/obese.
Significant individual differences in linear slopes and change over time were observed for waist circumference (WC) (-3.0 cm) only in unconditional model (t = -0.67, P = 0.02).
A 3.0 cm loss in WC shows that a 10,000 step per day walking program has the potential to influence changes in body composition measures that are correlated with adverse health outcomes. While significant changes did occur there are some limitations. The analysis did not consider the data regarding completing of 10,000 steps per day and other potential factors that could influence the results. Compliance to the walking dose and initial physical activity and body composition levels are important to consider when studying body composition changes in such programs.
PMCID: PMC4335484  PMID: 25741423
Work site, Intervention; Walking; Waist Circumference; Body Fat; Physical Activity
9.  A comparison of a social support physical activity intervention in weight management among post-partum Latinas 
BMC Public Health  2014;14:971.
Weight gain during the childbearing years and failure to lose pregnancy weight after birth contribute to the development of obesity in postpartum Latinas.
Madres para la Salud [Mothers for Health] was a 12-month, randomized controlled trial exploring a social support intervention with moderate-intensity physical activity (PA) seeking to effect changes in body fat, fat tissue inflammation, and depression symptoms in sedentary postpartum Latinas. This report describes the efficacy of the Madres intervention.
The results show that while social support increased during the active intervention delivery, it declined to pre-intervention levels by the end of the intervention. There were significant achievements in aerobic and total steps across the 12 months of the intervention, and declines in body adiposity assessed with bioelectric impedance.
Social support from family and friends mediated increases in aerobic PA resulting in decrease in percent body fat.
Trial registration Identifier: NCT01908959.
PMCID: PMC4177167  PMID: 25233867
Latinas; Hispanics; Physical activity; Social support; Overweight; Obesity; Exercise
10.  Physical Activity and Sedentary Behaviors in Postpartum Latinas: Madres para la Salud 
To describe the physical activity (PA) and sedentary behaviors of postpartum Latinas who are overweight or obese prior to initiating Madres para la Salud, a social-support mediated walking intervention to promote postpartum weight loss.
139 postpartum (13.6 ± 7.7 weeks since childbirth) women (age = 28.3 ± 5.6 years and BMI = 29.7 ± 3.5 kg.m2), recruited from Phoenix area Latino-serving organizations completed the Stanford Brief Activity Survey (SBAS) and concurrently wore an accelerometer (AG) and a pedometer for 7-days, and kept a PA record (PAR).
Most were classified as inactive and lightly active on the SBAS (51% inactive, 37% light, 11% moderate). Most time was spent in sedentary (512.0 ± 169.9 min.d−1) and light-intensity PA (242.4 ± 51.4 min.d−1) with less time in moderate-intensity lifestyle (78.3 ± 39.9 min.d−1), moderate-intensity walking (16.6 ± 14.4 min.d−1), and vigorous-intensity PA (0.34 ± 1.5 min.d−1). Pedometer steps.d−1 were low (total = 4,973 ± 2,202 steps; aerobic = 412 ± 774 steps) with most participants rated as sedentary (61%) or low-active (28.1%). Consistent with objective PA measures, PARs showed more time spent in light-intensity PAs such as home care, cooking, child- and self care tasks, occupation, religious events, and watching television.
By and large, the postpartum Latinas enrolled spent most of their day in low-intensity activity levels with little time spent in health-enhancing PA levels/behaviors. This demographic should be the focus of PA interventions to increase PA to health enhancing levels.
PMCID: PMC3686889  PMID: 23439416
Exercise; Hispanics; Accelerometer; Physical Activity Record; Self Report Questionnaire; Pedometer
11.  Utility of the Life Course Perspective in Research With Mexican American Caregivers of Older Adults 
Research on caregiving of elders in Mexican American families is urgently needed. We know little about family caregivers, family transitions in relation to the caregiving role, reciprocal impact of caregivers and care recipients on one another, adaptive strategies, positive benefits of caregiving (caregiver gain), specific caregiving burdens, or supportive interventions for family caregiving. Theory derivation using the concepts and structure of life course perspective provides a way to fill the knowledge gaps concerning Mexican American caregiving families, taking into account their ethnic status as an important Hispanic subgroup and the unique cultural and contextual factors that mark their caregiving experiences.
PMCID: PMC3750709  PMID: 18845694
Mexican American; life course perspective; elder caregiving
12.  Activities of Daily Living in Mexican American Caregivers: The Key to Continuing Informal Care 
Journal of family nursing  2012;18(4):439-466.
La familia drives elder care in Mexican–American (MA) families, but nursing home placement can result from day-to-day caregiving demands that increase caregiver difficulty with activities of daily living (ADLs). Using life course perspective, this article describes the initial data wave of 31 MA caregivers from a descriptive, longitudinal, mixed-methods study of 110 MA caregivers and care recipients over 15 months in their caregiving trajectories. Fifteen of 31 caregivers consistently indicated “no help needed” on the Katz ADL, whereas all but one reported “help needed” during semistructured interviews with cultural brokers. In addition to the discrepancy between results on the Katz ADL and interviews, findings include consideration of nursing home placement by moderately acculturated caregivers and minimization of their illnesses by caregivers. Additional methods of MA caregiver assessment may be needed due to the questionable accuracy of the Katz ADL; additional research should explore minimization and acculturation in MA caregivers.
PMCID: PMC3739688  PMID: 22740307
family caregivers; Mexican-American; activities of daily living; minimization
13.  Effects of a 6-Month Walking Study on Blood Pressure and Cardiorespiratory Fitness in U.S. and Swedish Adults: ASUKI Step Study 
Asian Journal of Sports Medicine  2013;4(2):114-124.
The aim of this study was to assess the effects of a six-month pedometer-based workplace intervention on changes in resting blood pressure (BP) and cardiorespiratory fitness (CRF).
A subsample of ASUKI Step participants (n= 355) were randomly selected to have changes in their BP and CRF monitored during the intervention. Pedometers were used to monitor steps taken with a goal of walking more than 10,000 steps/day. Systolic and diastolic BP were taken using an Omron automated BP cuff. Estimated VO2 max was obtained using the Åstrand-Rhyming cycle ergometer test. A multi-level growth modeling approach, and a mixed model ANOVA were used to predict changes in systolic and diastolic BP, and estimated VO2 max over time by steps, age, gender, and university site.
Steps/day averaged 12,256 (SD = 3,180) during month 1 and steadily decreased to month 6. There were significant linear and quadratic trends in systolic and diastolic BP over time. Age was positively related to initial starting values for systolic and diastolic BP, and approached significance for systolic BP changes over time. Steps/day approached significance for linear changes in systolic BP. There was a significant difference between ASU and KI participants’ estimated VO2 max. There was a significant change over time in the estimated VO2 max. The number of steps taken was significantly related to changes in estimated VO2 max over time.
The results of the present study indicate that healthy individuals who took part in a pedometer intervention improved several cardiovascular disease risk factors.
PMCID: PMC3690731  PMID: 23802053
Workplace; Physical Activity; Pedometer Intervention; Cardiorespiratory Fitness; Blood Pressure; VO2 Max
14.  Evaluation of a Peer-led Asthma Self-Management Program and Benefits of the Program for Adolescent Peer Leaders 
Respiratory care  2012;57(12):2082-2089.
Asthma is the leading chronic condition in adolescents. Nonetheless, research efforts to address adolescent asthma morbidity by applying a developmentally appropriate self-management intervention have been limited. Recently a peer-led asthma self-management program has been developed and implemented for adolescents. The purpose of the study was to assess the acceptability of a peer-led asthma program for adolescents based on participant feedback and to examine the program’s impact on asthma outcomes in peer leaders.
Adolescents with persistent asthma (N=91, 13–17 years) participated in a camp-based asthma program led by peer leaders (the intervention group) or healthcare professionals (the control group), and completed a set of program evaluation forms. Peer leaders (n=14, 16–20 years) completed study questionnaires measuring asthma knowledge, self-efficacy, asthma control and quality of life at baseline, immediately after camp, and 3-, 6- and 9-months post-camp.
The peer-led group reported more positive experience with the program than the adult-led group (p=.01, Cohen’s d=.53), particularly in its usefulness in dealing with asthma. Peer leaders were rated by participants highly on knowledge (98%), attitudes (93%–96%), personal skills (91%) and perceived similarities (80%–86%). Significant improvements were found in peer leaders’ knowledge (p<.001, η2 = .87), self-efficacy (p<.001, η2=.74), asthma control (p=.01, η2=.66) and quality of life in emotional functioning (p=.002, η2=.82) and activity (p=.003, η2=.62).
A peer-led asthma self-management program was successfully implemented and well received by adolescent learners. Asthma outcomes in peer leaders appear to have improved as a result of the program although caution should be exercised in determining clinical meaningfulness given the modest changes in mean scores.
PMCID: PMC3521097  PMID: 22710616
Asthma; Adolescents; Self-management; Peer-led program; Peer leaders
15.  Effects of a Peer-Led Asthma Self-Management Program for Adolescents 
To evaluate the effectiveness of a peer-led asthma self-management program for adolescents with asthma.
Randomized controlled trial comparing a peer-led asthma program (intervention group) vs. a conventional adult-led asthma program (control group). Each program was implemented at a full-day camp.
An urban city and adjacent suburbs in upstate New York.
112 Adolescents, ages 13–17 years, with persistent asthma.
Peer-led asthma self-management program implemented at a day camp.
Outcome Measures
The Children's Attitude toward Asthma Scale and the Pediatric Asthma-related Quality of Life Questionnaire were administered at baseline, and immediate, 3, 6 and 9 months post-intervention. Spirometry was conducted twice - prior to the intervention and 9 months post-intervention.
The intervention group reported more positive attitudes at 6-months post-intervention (mean difference [Diff]= 4.11, 95%CI:0.65–7.56) and higher quality of life at 6- (Diff=11.38, 95%CI:0.96–21.7) and 9-months post-intervention (Diff=12.97, 95%CI:3.46–22.48) than the control group. The intervention was found to be more beneficial to adolescents of male gender or low family income as shown by greater improvement in positive attitudes and quality of life than their counterparts.
An asthma self-management program led by peer leaders is a developmentally appropriate approach that can be effective in assisting adolescents with asthma in improving their attitudes and quality of life, particularly for males and those of low socioeconomic status.
PMCID: PMC3252732  PMID: 21646583
Asthma; Adolescents; Peer-led program; knowledge; attitudes; quality of life
16.  Madres para la Salud: Design of a Theory-based Intervention for Postpartum Latinas 
Contemporary clinical trials  2011;32(3):418-427.
Weight gain in young women suggests that childbearing may be an important contributor to the development of obesity in women. Depressive symptoms can interfere with resumption of normal activity levels following childbirth or with the initiation of or adherence to physical activity programs essential for losing pregnancy weight. Depression symptoms may function directly to promote weight gain through a physiologic mechanism. Obesity and its related insulin resistance may contribute to depressed mood physiologically. Although physical activity has well-established beneficial effects on weight management and depression, women tend to under participate in physical activity during childbearing years. Further, the mechanisms underpinning the interplay of overweight, obesity, physical activity, depression, and inflammatory processes are not clearly explained.
This report describes the theoretical rationale, design considerations, and cultural relevance for “Madres para la Salud” [Mothers for Health].
Design and Methods
Madres para la Salud is a 12 month prospective, randomized controlled trial exploring the effectiveness of a culturally specific intervention using “bouts” of physical activity to effect changes in body fat, systemic and fat tissue inflammation, and postpartum depression symptoms in sedentary postpartum Latinas.
The significance and innovation of Madres para la Salud includes use of a theory-driven approach to intervention, specification and cultural relevance of a social support intervention, use of a Promotora model to incorporate cultural approaches, use of objective measures of physical activity in post partum Latinas women, and the examination of biomarkers indicative of cardiovascular risk related to physical activity behaviors in postpartum Latinas.
PMCID: PMC3070052  PMID: 21238614
Latinas; Hispanics; physical activity; intervention; social support; overweight; obesity; culture; postpartum; exercise
17.  Mexican-American Males Providing Personal Care for their Mothers 
We know little about Mexican-American (MA) family adaptation to critical events in the informal caregiving experience but, in these days of economic and social turmoil, sons must sometimes step up to provide personal care for their aging mothers. This article compares two empirically real cases of MA males who provided such care, in lieu of a female relative. The cases are selected from a federally-funded, descriptive, longitudinal, mixed methods study of 110 MA caregivers and their care recipients. In case-oriented research, investigators can generate propositions (connected sets of statements) that reflect their findings and conclusions, and can be tested against subsequent cases: Caregiving strain and burden in MA males may have more to do with physical and emotional costs than financial ones; MA males providing personal care for their mothers adopt a matter-of-fact approach as they act “against taboo”; and this approach is a new way to fulfill family obligations.
PMCID: PMC3106309  PMID: 21643486
Mexican-American; males; caregivers; strain; burden
18.  Adolescents’ Perception of Asthma Symptoms and Health Service Utilization 
Pediatric asthma is accountable for a substantial use of health care services. The purpose of this study was to systemically examine the extent to which inaccurate perception of asthma symptoms is associated with the use of health care services.
This exploratory study included 126 adolescents with asthma, aged between 13–20 years. Subjects were classified as having inaccurate symptom perception (IG), well controlled, accurate symptom perception (WCA), and poorly-controlled accurate symptom perception (PCA). These groups were compared with respect to health care utilization including emergency department (ED) visits, hospitalization and office visits and school absenteeism in the past 3 months.
More adolescents in the inaccurate group had at least one hospitalization compared to adolescents in the PCA or WCA groups (23.1% vs. 11.1% vs. 2.6% respectively). A similar trend was seen for emergency department visits. Compared to WCA group, adolescents in the inaccurate group were nearly 9 times more likely to have been hospitalized, 3.4 times more likely to have visited an emergency department (ED), and 4 times more likely to have missed school days.
Adolescents with inaccurate symptom perception are more likely to have hospitalizations, ED visits, and missed days from school as compared to those with accurate perceptions. The findings underscore the importance of screening for perceptual accuracy of asthma symptoms and call for interventions promoting accurate symptom assessment in adolescents with asthma to assure appropriate care.
PMCID: PMC3060703  PMID: 21320682
19.  Family Support and Asthma Outcomes in Adolescents: Barriers to Adherence as a Mediator 
Asthma morbidity in children is associated with family psychosocial functioning. While the family plays a pivotal role in maintaining optimal asthma care the mechanism of how family support influences asthma outcomes is not well understood. The purpose of this study was to examine the role of barriers to adherence in mediating the impact of family support on asthma outcomes in adolescents.
The sample included 126 adolescents with asthma aged 13 to 20 years, living in the Northeast United States. The sample consisted of 49% Whites and 51% minorities including primarily Blacks (38%) followed by Hispanic (11%). Adolescents provided self-reported data. Structural equation modeling was performed to examine the direct and indirect relationships between family support and asthma outcomes.
Family support was positively associated with asthma control and quality of life. These significant associations were mediated by barriers to adherence. Particularly, family support was found to reduce barriers concerning adolescents’ negative attitudes toward medication and healthcare providers, which in turn improved asthma control and quality of life symptoms, emotional functioning and activity domains. Adolescents’ cognitive difficulty also tended to mediate the relationship between family support and emotional functioning.
This study highlights the beneficial effects of family support in improving asthma outcomes in adolescents. Family support exerts the positive effect by ameliorating barriers to treatment adherence in adolescents, particularly the barriers associated with negative attitudes and cognitive challenges. The findings underscore the importance of incorporating family assessment and intervention in caring for adolescents with asthma.
PMCID: PMC2963868  PMID: 20970082
Asthma; Adolescents; Family support; Asthma control; Quality of life; Barriers
Recruiting older adults to participate in intervention research is essential for advancing the science in this field. Developing a relevant recruitment plan responsive to the unique needs of the population before beginning a project is critical to the success of a research study. This paper describes our experiences in the process of recruitment of homebound older adults to test a community-based health empowerment intervention. In our study, the trust and partnership that existed between the research team and Community Action Agency facilitated the role of the home-delivered meal drivers as a trusted and untapped resource for study recruitment. Researchers can benefit from thinking creatively and developing meaningful partnerships when conducting research with older adults.
PMCID: PMC2818200  PMID: 20128539
22.  Fatigue-Based Subgroups of Breast Cancer Survivors with Insomnia 
Cancer nursing  2009;32(5):404-411.
The purpose of this study was to determine if breast cancer survivors (BCS) with insomnia can be grouped according to their level of fatigue. A secondary data analysis was conducted on baseline data obtained from a randomized clinical trial that focused on a cognitive-behavioral intervention for insomnia in BCS. Participants were breast cancer survivors (n=86) with insomnia who were at least 3 months post completion of primary treatment without current evidence of disease. Three subgroups of women were identified with significant differences in fatigue, including: Exhausted (35%), Tired (41%), and Restored (24%). Results suggest a majority of women have moderate-to-severe fatigue many years post completion of treatment. Severe fatigue was associated with higher levels of other symptoms and poorer quality of life (Exhausted subgroup). Significant differences in insomnia severity, anxiety, depression, and quality of life were noted among the Exhausted, Tired and Restored subgroups. The existence of fatigue-based subgroups offers important information when providing care to BCS. By determining symptoms associated with fatigue, patient care will benefit through a shift in focus from treatment of a single symptom such as fatigue to the delivery of a tailored intervention that targets multiple symptoms.
PMCID: PMC2892713  PMID: 19661794
23.  Spirituality and Cultural Identification Among Latino and Non-Latino College Students 
The purposes of this study were to examine (a) differences in spiritual perspectives and practices of Latino and non-Latino young adults and (b) the cultural relevance of the Latino Spiritual Perspective Scale (LSPS). Studies indicate that spiritual perspectives are embedded within cultural group norms and vary significantly across ethnic groups. A cross-sectional survey design was used with a convenience sample of 223 Latino and non-Latino university students in the Southwestern United States. The Spiritual Perspective Scale (SPS), the LSPS, the Orthogonal Cultural Identification Scale, and a demographic questionnaire were used. Latinos scored significantly higher than non-Latinos in both measures of spiritual perspectives. Self-reported behavioral measures, such as frequency of personal prayer, were also higher among the Latino group. Latino cultural identification was the only significant predictor of LSPS scores. Findings from this study indicate that spirituality among Latinos has meanings specific to the cultural group context. These findings have implications for nursing research involving the conceptualization and measurement of spirituality among multiethnic groups.
Los propósitos de este estudio eran examinar: (a) diferencias en perspectivas espirituales y prácticas de jóvenes Latinos y no Latinos; y (b) la relevancia cultural de la Escala de la Perspectiva Espiritual Latina. Estudios indican que perspectivas espirituales están incrustadas entre normas culturales del grupo y varían considerablemente entre grupos étnicos. Un diseño transversal y de encuesta fue utilizado con una muestra de conveniencia de 233 estudiantes universitarios Latinos y no Latinos en el Suroeste de los Estados Unidos. La Escala de la Perspectiva Espiritual (EPE), la Escala de la Perspectiva Espiritual Latina (EPEL), la Escala Ortogonal de Identificación Cultural, y un cuestionario demográfico fueron utilizados. Los Latinos calificaron considerablemente más alto que los no Latinos en ambas medidas de perspectivas espirituales. Medidas de comportamiento auto-reportadas, como la frecuencia de oración, también estuvieron más altas en el grupo Latino. La identificación con la cultura Latina fue el único vaticinador de las calificaciones de la EPEL. Los resultados de este estudio indican que la espiritualidad entre Latinos tiene significados específicos al contexto del grupo cultural. Estas conclusiones tienen implicaciones para las investigaciones de enfermería que involucran la conceptualización y medida de la espiritualidad entre grupos multiétnicos.
PMCID: PMC2822391  PMID: 20165566
spirituality; religious practices; cultural identification; instrumentation
24.  Barriers to Asthma Self-Management in Adolescents: Relationships to Psychosocial Factors 
Pediatric pulmonology  2009;44(2):183-191.
Asthma morbidity in adolescents often results from inadequate asthma self-management. This study was to explore barriers to self-management perceived by adolescents and to examine the associations between barriers and psychosocial factors including knowledge, attitude and self-efficacy. This cross-sectional study included a total of 126 adolescents with asthma (13–21 years) representing diverse race/ethnicity groups with a wide range of socioeconomic status. Self-reported data were analyzed using descriptive statistics, factor analysis and hierarchical regression. The most frequently endorsed barrier (63%) was adolescents’ unwillingness to give up “the things the doctors say I have to give up,” followed by difficulty in remembering to take care of their asthma (53%), and then “trying to forget” that they have asthma (50%). Psychosocial factors accounted for 32% of the variance in total barrier perceptions. Factor analysis revealed barriers in four domains including negativity toward providers and the medication regimen, cognitive difficulty, peer/family influence and denial. Self-efficacy was found to be the most influential factor that showed strong negative association with all four barrier subscales independent of the levels of asthma control and sociodemographic characteristics. Poor attitudes toward asthma were also associated with barriers of cognitive difficulty and social influence after adjusting for other factors. Males consistently reported higher total barriers and barriers of negativity, social influence and denial. The gender differences were not explained by psychosocial and sociodemographic factors. This study suggests that psychosocial factors are strong predictors of barriers to self-management in adolescents. Particularly, promoting self-efficacy may be beneficial in addressing the barriers. Special attention is needed to address the higher propensity for barriers in males.
PMCID: PMC2692882  PMID: 19142893
Asthma; Adolescents; Barriers; Self-management; Psychosocial factors
Research in nursing & health  2009;32(1):18-30.
We used autoregressive latent trajectory (ALT) modeling to examine the relationship between change in nurse staffing and change in medication errors over 6 months in 284 general medical-surgical nursing units. We also investigated the impact of select hospital and nursing unit characteristics on the baseline level and rate of change in medication errors. We found essentially no support for a nurse staffing – medication error relationship either cross-sectionally or longitudinally. Few hospital or nursing unit characteristics had significant relationships to either the baseline level or rate of change in medication errors. However, ALT modeling is a promising technique that can promote a deeper understanding of the theoretically complex relationships that may underlie the nurse staffing – medication error relationship.
PMCID: PMC2628558  PMID: 18825733
nurse staffing; medication errors; methodology

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